Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Epilogue
  The objectives of this project are to circumvent the classical techniques of tissue transplantation for reconstructive procedures which require multiple operative procedures and prolonged hospitalization. Blocks of composite tissue will be transplanted in animals by the anastomosis of vessels in the realm of 1 mm. O.D. Recent improvements in instrumentation, the development of microminiature needles electroplated on 10 micron nylon sutures, and the use of a binocular two-man operating microscope have made such anastomoses possible. The feasibility of this approach has been established by three successful experimental projects completed by the principal investigator. Further experiments in primates are designed to standardize techniques and train others. The direct transfer of these techniques to humans is the final objective of this project.

Primates have been selected as the experimental animal for this study because of their close anatomical similarity to man, particularly in the hand and facial features. In our experience they tolerate prolonged surgical procedures well, and can be used repeatedly for a wide variety of experiments, the results of which are directly transferable to man.

1. Clinical Transplantation: This will be a continuation of work under study. The hallux of the Rhesus monkey will be transplanted to the thumb position by anastomosing the vessels of the toe to the thumb vessels and repairing the tendons and nerves. Viability of the transplanted tissue will be followed by infrared heat sensing devices. Surface temperature has been the best early index of survival. Microminiature electrodes and thermocouples have been developed by our Consultant Physicist and will be used to plot temperature gradients of deeper tissues. Late results will be evaluated by the degree of return of sensation and voluntary motion. The small muscles will be studied by electrical stimulation and biopsies. Periodic xrays and arteriograms will be used to evaluate bone and joint changes and vascular patency. Approximately 20 procedures on 10 animals are contemplated over a six month period.


2. Neurovascular Island Transplants: Large and small islands of composite tissue will be transplanted from one site to another by microminiature vascular and nerve repair, to fill defects, build experimental ears, noses, and other acral parts. Viability of the transplant will be evaluated by the above techniques. The effects of vasoplegic agents and local hypothermia will be studied. Tubing drawn out to 3 to 4 microns in diameter will be implanted at the vascular repair site for the remote administration of drugs. The incorporation of a cooling system in the plaster cast dressing is under study.

3. Vascularized bone and joint transplant. 1. Rib segments will be mobilized on their intracostal vessels and transferred to defects in the jaw, forearm, and leg. 2. Toe joints on vascularized pedicles will be transplanted to replace the tempromandibular joint. Results will be evaluated as in experiments 1 and 2.

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